Field of Invention
The present disclosure is related to the field of robot-assisted surgery.
Description of the Related Art
Robotic surgical systems are useful in minimally invasive surgery by enhancing the vision and dexterity of the surgeon. The Da Vinci from Intuitive Surgical is the only commercial robot for soft-tissue surgery on the market today. The Da Vinci system has advanced the field of surgery by providing a less invasive alternative to open procedures (i.e. prostatectomy or hysterectomy) by enabling the surgeon to access and manipulate in difficult to reach anatomical regions, such as deep in the pelvis or the retroperitoneum. Today, over 90% of Da Vinci cases are genitourinary procedures performed in the in the pelvic cavity, such as prostatectomy, hysterectomy, cystectomy, pyeloplasty, sacrocolpopexy, myomectomy, and endometriosis resection. In 2011, there were 360,000 procedures done with the Da Vinci system, among which prostatectomy and hysterectomy account for 75% of these procedures [Intuitive Surgical Inc. Annual Report 2012].
Da Vinci's key value proposition is that it enables Urologist/Gynecologist to access hard to reach deep and tight pelvic spaces in order to perform laparoscopic surgeries with enhanced 3D visualization and improved dexterity, which would otherwise be technically very challenging using a traditional laparoscopic approach. It is best suited for operation in a relatively small field and for precision dissection in a confined volume, but it is not suitable for larger interventions, such as mobilization of the colon, because these types of procedures usually require wide ranges of motion. Previous studies showed that intuitive controls of robotic systems are more comparable to the motions performed by a surgeon during open surgery and can shorten the procedure learning curve, even in the hands of relatively inexperienced laparoscopic surgeons. Ahlering et al. demonstrated a similar finding in urological surgery, where a robotic interface allowed a surgeon with limited laparoscopic familiarity to perform minimally invasive radical prostatectomy, with results comparable to those of an experienced laparoscopic surgeon, after completing only twelve cases [Ahlering, et al. J Urol 2003].
Despite the utility of Da Vinci in pelvic surgeries, the technology in its current form is not suited for general surgery, especially colorectal resection during which multiple quadrants of the abdomen are traversed and the surgeon must often adjust or tilt the patient and operating table to achieve better access to target tissues. In order to effectively use robotics in procedures such as this, physicians would need to greatly modify their technique or dock and undock the robot in the middle of the procedure, which can significantly increase operating times and possibly increase the risk of harming the patient. For instance, a total robotically performed sigmoid colectomy requires undocking the robot from the upper abdominal ports, repositioning the patient, moving the robot and re-docking to the lower abdominal ports. An action that usually takes a couple of seconds in conventional laparoscopy has become a cumbersome 10 minute or more exercise performed by specialized assistants.
A further shortcoming of current robotic systems is their large footprint on both master and slave sides, which can impede access to the patient lying on the operating table, and also poses a significant challenge for proper patient positioning and port placement. Even small deviations in port placement could result in collision of the robotic arms or failure to reach the intended target area. It also lacks haptic feedback (tactile and force feedback), making it unsuitable for surgical anastomosis as these require water-tight and tension-free suturing to mitigate the chance of anastomosis breakdown post-operatively. According to our survey of surgeons, there is very limited application for Da Vinci in colorectal surgery, even with its recently approved Endo Wrist Stapler. There might be a very small niche for it, such as lower anterior rectal resection deep in the pelvis and anastomosis can be accomplished by using a trans-anal circular stapler.
Traditional minimally invasive colorectal surgeries include the following stages: (1) Careful dissection to provide adequate hemostasis and obtain access to the target tissue; (2) Repair (as in treatment of a perforation) or bypass/removal of a lesion (as in colorectal cancer); (3) Anastomosis of the remaining ends of bowel; (4) Irrigation of the abdominal and pelvic cavities if indicated; and (5) Appropriate closure of the fascia and skin. Each of these basic stages has very different design requirements when utilizing a robotic system. In the exploration stage, the ideal system would provide a wide range of motion for identifying the target tissue and for optimal use of surgical tools. The second and third stages typically require a long operating time, and put a great amount of physical strain on the surgeon. A system that enhances surgeon's dexterity as well as providing arm support is needed.
In summary, current robotic system enable the surgeons in some disciplines to perform MIS (Minimally Invasive Surgery) procedures otherwise difficult to do. However, a more flexible, modular, intelligent robotic functionality is needed to facilitate the use of robotically assisted MIS in the general surgery field. There is a clear clinical need for a system that not only lowers the technical barriers for performing MIS procedures, but also improves surgical outcome and efficiency.
Several previous patents describe devices meant to aid the surgeon by constraining motions and providing support. U.S. Pat. No. 5,397,323, entitled “Remote center-of-motion robot for surgery,” and U.S. Publication 2009/0240259, entitled “System and methods for controlling surgical tool elements,” both describe systems that would limit the movement of a tool with a remote degree of freedom and allow for robotic master-slave control.
U.S. Publication 2007/0250078, entitled “Surgical manipulator,” describes a device that can position a surgical tool and provide haptic feedback.
U.S. Publication 2012/0283747, entitled “Human-robot shared control for endoscopic assistant robot,” describes a robotic-arm positioning system that can support an endoscope that can be operated with preloaded procedures or manually with varying stiffness.
U.S. Pat. No. 6,239,784, entitled “Exo-skeletal haptic computer human/computer interface device,” describes a hand-mounted exoskeleton glove-like haptic interface that can be used to interact with computers.
U.S. Pat. No. 6,413,229, entitled “Force-feedback interface device for the hand,” describes a similar haptic glove-like interface that can be mounted in different ways and be used to manipulate both virtual and physical objects.
U.S. Pat. No. 5,954,692, entitled “Endoscopic robotic surgical tools and methods,” describes a wearable encoder/robotic interface that allows direct control of surgical instruments.
U.S. Pat. No. 8,188,843, entitled “Haptic device gravity compensation,” describes a haptic input device with gravity compensation.
U.S. Pat. No. 8,332,072, entitled “Robotic Hand Controller,” describes a robotic hand controller with 8 degrees of freedom with force feedback.
U.S. Publication 2008/0009771, entitled “Exosceleton,” describes a wearable structure with links and joints corresponding to the human body. Transducers on the structure allow for exchange of motion and information between structure and user, and enable control of movement of the structure.
EP 0774329A, entitled “Telerobotic laparoscopic manipulator,” describes a manipulatable hand for use in laparoscopic surgery having a controlled hand remote from the operator, and having at least one controlled finger.
U.S. Pat. No. 7,813,784, entitled “Interactive computer-assisted surgery system and method,” describes a method and system for providing computer assistance for performing a medical procedure.
U.S. Pat. No. 7,747,311, entitled “System and method for interactive haptic positioning of a medical device,” describes a combination of a haptic device and a computer-assisted system for interactive haptic positioning. The entire disclosure of each of the above references is hereby incorporated by reference into this specification.
However, none of the above references involve utilizing features of the present disclosure to perform robot-assisted surgery with the robotic arm and end-effector tethered to the operator's arm. None have described a control console positioned on the robotic arm nor a universal adapter that mechanizes endoscopic tools. Furthermore, none of the above references describe a system that allows easy exchange between the different operation modes: manual, master-slave, and autonomous.